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Ranking Surgeon Performance After ACL Reconstruction Using the Knee Injury and Osteoarthritis Outcome Score (KOOS)

Sarah B Floyd^1,2, Briggs Ahearn³, Michael J Kissenberth³

¹Department of Public Health Sciences, Clemson University, Clemson, South Carolina, USA.

Orthopaedic Journal of Sports Medicine

|January 30, 2025

Summary

This summary is machine-generated.

This study developed a risk-adjusted surgeon performance measure for anterior cruciate ligament reconstruction (ACLR) using patient-reported outcomes. Surgeon performance varied significantly across different KOOS subscales, highlighting the need for careful selection of outcome measures.

Keywords:

ACL KOOS PRO knee outcomes performance measures

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Area of Science:

Orthopaedic Surgery
Sports Medicine
Value-Based Healthcare

Background:

Patient-reported outcomes (PROs) are crucial for evaluating value-based care in orthopaedics.
Limited evidence exists on implementing PROs for surgeon performance evaluation.
This study addresses the need for objective surgeon performance metrics in orthopaedics.

Purpose of the Study:

To develop a risk-adjusted surgeon performance measure using the Knee injury and Osteoarthritis Outcome Score (KOOS).
To evaluate surgeon performance in patients undergoing anterior cruciate ligament reconstruction (ACLR).

Main Methods:

A cross-sectional study analyzed data from 1248 patients undergoing ACLR by 40 surgeons.
Linear regression was used to predict KOOS subscale change scores, adjusting for baseline characteristics.
Risk-adjusted performance measures were calculated, and surgeon quartiles were compared across KOOS subscales.

Main Results:

Older age, diabetes, smoking, cartilage damage, and lower baseline health scores negatively impacted KOOS outcomes.
Surgeon performance rankings varied across KOOS subscales, with some surgeons showing consistent performance and others showing variability.
Thirty surgeons' performance varied by 1-2 quartiles across different KOOS subscales.

Conclusions:

Surgeon performance in ACLR varies significantly depending on the KOOS subscale used for evaluation.
The ADL and Symptoms KOOS subscales are recommended for differentiating surgeon performance in ACLR patients.
Comprehensive PRO sets or a single, sensitive index PRO may be necessary for holistic surgeon performance evaluation.